Lewis-Clark Valley report highlights economic stress, inaffordability of health care

Families one catastrophe away from choosing between medication and rent. Transportation options severed, cutting off access to health care. Children’s dental care only accessible more than 50 miles away.

These are all snapshots detailed in the Innovia Foundation’s new community needs and opportunity assessment for the Lewis-Clark Valley Healthcare Foundation.

The report used community surveys and forums and compiled health data to gather a collective picture of what the three-state, nine-county region needs, health or otherwise. The region covers the fairly rural Idaho counties – Latah, Clearwater, Nez Perce and Lewis – along with Asotin and Garfield counties in Washington and Wallowa County in Oregon.

The community needs assessment highlighted residents’ challenges with many social determinants of health, including low wages, high cost of living and housing affordability.

Carol Moehrle, director of the north-central Idaho health district, said the report echoed similar findings the district uncovered in surveys in 2016 and even back in 2013.

“It makes me feel like we’re still focused in the right direction, but we also have a ways to go,” she said. “Income is one of those (factors) that then affects affordable housing and food and whether or not they can pay their bills to see the doctor and everything else.”

Residents surveyed identified affordable dental care, medical care and mental health services as the top health needs in the region. Affordability was a main concern.

“Cost of medical insurance co-pays and deductibles are the largest expense and concern for this household,” one survey respondent wrote. “We save what we can to cover these expenses but cannot afford it if we both have an issue, which leads to skipping medications and doctor visits.”

Approximately 1 in 10 respondents reported being unable to see a doctor in the past 12 months due to inability to pay, and 1 in 8 reported that lack of convenient appointment times prevented access.

“Idaho is expanding Medicaid which is wonderful for affordability, but we’re hoping there will be access they can gain,” Moehrle said. “We hope that will help affordability, but a lot of people in our areas have to choose between going to the doctor, paying for their prescriptions and medical bills and buying food, and it’s just heartbreaking that we are still in that dilemma and situation.”

Medicaid expansion might make health care more affordable, but dental access is already a challenge for Idaho children with Medicaid.

“It is very difficult to find local dentists that accept Medicaid for my children,” one survey respondent said. “We have to drive over 70 miles for appointments with our dentist because they are the only providers that accept Medicaid within 200 miles.”

Among all survey respondents, 15% reported accessing nonemergency care in the emergency room because they were unable to see a primary care provider. Top health issues in the region, as reported by those surveyed, are high blood pressure, obesity and mental health.

Moehrle said there are food deserts in the five-county Idaho region, and sometimes access to fresh food and grocery stores can mean crossing county lines.

Many of the counties included in the Innovia assessment have higher suicide mortality rates than the national average. The north-central Idaho health district is also working on creating mental health crisis centers in each county. So far, they have completed three of five, Moehrle said. The district plans to open two more in 2020.

“It keeps these people in their communities also which is where their support systems are and helps their recovery process,” Moehrle said.

Former Idaho lawmaker and doctor John Rusche serves as the chairman of the LCVH Foundation, and he said the assessment will be used to help the board focus on where grants should be awarded.

“That’s always good to help people when they are hungry and cold, but how do you work to change the society and the system so there are less people who are hungry and cold?” Rusche said. “If part of the problem is they can’t afford health care then what are you doing to make it more affordable to them?”

The foundation awards two types of grants: fast-track for smaller expenses and annual for long-term work. Rusche said the region has enough organizations to do the work, although they might need enhanced training or resources.

“We are here to help the nonprofits develop the best plan and get started on things like low-income housing, health care and hunger,” Rusche said.

The report opted out of specific policy recommendations, leaving those decisions to the LCVH Foundation board’s funding power.

“I hope it lays the foundation for some data-informed decision-making,” said Mason Burley, director of research at Innovia, who conducted the study.

The foundation’s board will meet to plan its 2020 grant cycle in the next month.

Editor’s note: Reporter Arielle Dreher’s position is funded through grants, including one from the Innovia Foundation.